Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2003 Sep;74(9):1245–1249. doi: 10.1136/jnnp.74.9.1245

Amygdala volumetry in "imaging-negative" temporal lobe epilepsy

S Bower 1, S Vogrin 1, K Morris 1, I Cox 1, M Murphy 1, C Kilpatrick 1, M Cook 1
PMCID: PMC1738652  PMID: 12933928

Abstract

Objective: Although amygdala abnormalities are sometimes suspected in "imaging-negative" patients with video EEG confirmed unilateral focal epilepsy suggestive of temporal lobe epilepsy (TLE), amygdala asymmetry is difficult to assess visually. This study examined a group of "imaging-negative" TLE patients, estimating amygdala volumes, to determine whether cryptic amygdala lesions might be detected.

Methods: Review of video EEG monitoring data yielded 11 patients with EEG lateralised TLE and normal structural imaging. Amygdala volumes were estimated in this group, in 77 patients with pathologically verified hippocampal sclerosis (HS), and in 77 controls.

Results: Seven of 11 "imaging-negative" cases had both significant amygdala asymmetry and amygdala enlargement, concordant with seizure lateralisation. Although significant amygdala asymmetry occurred in 35 of 77 HS patients, it was never attributable to an abnormally large ipsilateral amygdala. Compared with patients with HS, patients with amygdala enlargement were less likely to have suffered secondarily generalised seizures (p<0.05), and had an older age of seizure onset (p<0.01).

Conclusion: Abnormal amygdala enlargement is reported in seven cases of "imaging-negative" TLE. Such abnormalities are not observed in patients with HS. It is postulated that amygdala enlargement may be attributable to a developmental abnormality or low grade tumour. It is suggested that amygdala volumetry is indicated in the investigation and diagnosis of "imaging-negative" TLE.

Full Text

The Full Text of this article is available as a PDF (188.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berkovic S. F., Andermann F., Olivier A., Ethier R., Melanson D., Robitaille Y., Kuzniecky R., Peters T., Feindel W. Hippocampal sclerosis in temporal lobe epilepsy demonstrated by magnetic resonance imaging. Ann Neurol. 1991 Feb;29(2):175–182. doi: 10.1002/ana.410290210. [DOI] [PubMed] [Google Scholar]
  2. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  3. Bower S., Vogrin S., Kilpatrick C., Morris K., Cook M. Hippocampal damage and duration of temporal-lobe epilepsy. Lancet. 1998 Jul 4;352(9121):66–67. doi: 10.1016/S0140-6736(05)79549-0. [DOI] [PubMed] [Google Scholar]
  4. Bronen R. A., Fulbright R. K., Kim J. H., Spencer S. S., Spencer D. D., al-Rodhan N. R. Regional distribution of MR findings in hippocampal sclerosis. AJNR Am J Neuroradiol. 1995 Jun-Jul;16(6):1193–1200. [PMC free article] [PubMed] [Google Scholar]
  5. Cascino G. D., Jack C. R., Jr, Parisi J. E., Sharbrough F. W., Hirschorn K. A., Meyer F. B., Marsh W. R., O'Brien P. C. Magnetic resonance imaging-based volume studies in temporal lobe epilepsy: pathological correlations. Ann Neurol. 1991 Jul;30(1):31–36. doi: 10.1002/ana.410300107. [DOI] [PubMed] [Google Scholar]
  6. Cendes F., Andermann F., Gloor P., Evans A., Jones-Gotman M., Watson C., Melanson D., Olivier A., Peters T., Lopes-Cendes I. MRI volumetric measurement of amygdala and hippocampus in temporal lobe epilepsy. Neurology. 1993 Apr;43(4):719–725. doi: 10.1212/wnl.43.4.719. [DOI] [PubMed] [Google Scholar]
  7. Cendes F., Andermann F., Gloor P., Gambardella A., Lopes-Cendes I., Watson C., Evans A., Carpenter S., Olivier A. Relationship between atrophy of the amygdala and ictal fear in temporal lobe epilepsy. Brain. 1994 Aug;117(Pt 4):739–746. doi: 10.1093/brain/117.4.739. [DOI] [PubMed] [Google Scholar]
  8. Cook M. J., Fish D. R., Shorvon S. D., Straughan K., Stevens J. M. Hippocampal volumetric and morphometric studies in frontal and temporal lobe epilepsy. Brain. 1992 Aug;115(Pt 4):1001–1015. doi: 10.1093/brain/115.4.1001. [DOI] [PubMed] [Google Scholar]
  9. Corsellis J. A. The neuropathology of temporal lobe epilepsy. Mod Trends Neurol. 1970;5(0):254–270. [PubMed] [Google Scholar]
  10. GREEN J. R., SCHEETZ D. G. SURGERY OF EPILEPTOGENIC LESIONS OF THE TEMPORAL LOBE. Arch Neurol. 1964 Feb;10:135–148. doi: 10.1001/archneur.1964.00460140021004. [DOI] [PubMed] [Google Scholar]
  11. Gambardella A., Gotman J., Cendes F., Andermann F. The relation of spike foci and of clinical seizure characteristics to different patterns of mesial temporal atrophy. Arch Neurol. 1995 Mar;52(3):287–293. doi: 10.1001/archneur.1995.00540270083023. [DOI] [PubMed] [Google Scholar]
  12. Hudson L. P., Munoz D. G., Miller L., McLachlan R. S., Girvin J. P., Blume W. T. Amygdaloid sclerosis in temporal lobe epilepsy. Ann Neurol. 1993 Jun;33(6):622–631. doi: 10.1002/ana.410330611. [DOI] [PubMed] [Google Scholar]
  13. Jensen I., Klinken L. Temporal lobe epilepsy and neuropathology. Histological findings in resected temporal lobes correlated to surgical results and clinical aspects. Acta Neurol Scand. 1976 Nov;54(5):391–414. doi: 10.1111/j.1600-0404.1976.tb04372.x. [DOI] [PubMed] [Google Scholar]
  14. King D., Bronen R. A., Spencer D. D., Spencer S. S. Topographic distribution of seizure onset and hippocampal atrophy: relationship between MRI and depth EEG. Electroencephalogr Clin Neurophysiol. 1997 Dec;103(6):692–697. doi: 10.1016/s0013-4694(97)00090-4. [DOI] [PubMed] [Google Scholar]
  15. Miller L. A., McLachlan R. S., Bouwer M. S., Hudson L. P., Munoz D. G. Amygdalar sclerosis: preoperative indicators and outcome after temporal lobectomy. J Neurol Neurosurg Psychiatry. 1994 Sep;57(9):1099–1105. doi: 10.1136/jnnp.57.9.1099. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Moriarty J., Varma A. R., Stevens J., Fish M., Trimble M. R., Robertson M. M. A volumetric MRI study of Gilles de la Tourette's syndrome. Neurology. 1997 Aug;49(2):410–415. doi: 10.1212/wnl.49.2.410. [DOI] [PubMed] [Google Scholar]
  17. Van Paesschen W., Connelly A., Johnson C. L., Duncan J. S. The amygdala and intractable temporal lobe epilepsy: a quantitative magnetic resonance imaging study. Neurology. 1996 Oct;47(4):1021–1031. doi: 10.1212/wnl.47.4.1021. [DOI] [PubMed] [Google Scholar]
  18. Watson C., Andermann F., Gloor P., Jones-Gotman M., Peters T., Evans A., Olivier A., Melanson D., Leroux G. Anatomic basis of amygdaloid and hippocampal volume measurement by magnetic resonance imaging. Neurology. 1992 Sep;42(9):1743–1750. doi: 10.1212/wnl.42.9.1743. [DOI] [PubMed] [Google Scholar]
  19. Watson C., Nielsen S. L., Cobb C., Burgerman R., Williamson B. Medial temporal lobe heterotopia as a cause of increased hippocampal and amygdaloid MRI volumes. J Neuroimaging. 1996 Oct;6(4):231–234. doi: 10.1111/jon199664231. [DOI] [PubMed] [Google Scholar]
  20. Wolf H. K., Aliashkevich A. F., Blümcke I., Wiestler O. D., Zentner J. Neuronal loss and gliosis of the amygdaloid nucleus in temporal lobe epilepsy. A quantitative analysis of 70 surgical specimens. Acta Neuropathol. 1997 Jun;93(6):606–610. doi: 10.1007/s004010050658. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES